三维超声心动图及斑点追踪技术评价血液透析患者右心室功能-东南大学学报医学版

三维超声心动图及斑点追踪技术评价血液透析患者右心室功能

单位：汕头市中心医院超声医学科, 广东汕头 515031

分类号：R445; R459.5; R540.45

出版年·卷·期（页码）：2023·42·第三期（391-398）

摘要：

目的: 探讨应用三维超声心动图(3DE)及二维斑点追踪成像(2D-STI)定量评价终末期肾脏病(ESRD)患者血液透析前后右心室功能变化、透析中低血压(IDH)患者右心室收缩功能及预测IDH的价值。方法: 选取临床确诊为ESRD并行维持性血液透析治疗的患者124例为ESRD组,根据患者有无发生IDH分为IDH组56例和非IDH组68例。同时选取健康者40例为对照组。收集ESRD组和对照组基础资料及常规超声心动图资料,获得3D-RVEF、2D-RVFAC、RVFWLS、RVGLS等参数,记录ESRD患者在透析前后1 h内的超声资料及透析资料。最后比较ESRD患者透析前后参数的差异,分析超滤量和超滤率的相关因素;比较IDH组与非IDH组右心室功能参数的差异,探讨IDH的预测因素。结果: (1)与透析前相比,透析后ESRD组3D-RVEF、RVFWLS、RVGLS增加,右心横径、右心容积减小,肱动脉收缩压、肺动脉收缩压下降(P<0.05)。(2) ESRD组透析前后TAPSE变化值与透析超滤量呈负相关(r=-0.300,P<0.05)。(3)与非IDH组相比,IDH组透析前、后的3D-RVEF及2D-RVFAC均较低(P<0.05)。(4)多因素Logistic回归分析显示透析前3D-RVEF为IDH的独立预测因素。(5) ROC曲线分析显示透析前3D-RVEF诊断IDH的敏感度及特异度较高,3D-RVEF以截断值53.75%诊断IDH的敏感度为64.3%,特异度为88.2%,Youden指数为0.525。结论: (1)3DE及2D-STI可定量评价ESRD患者血液透析前后右心室功能变化。(2) IDH患者右心室收缩功能明显低于非IDH患者,透析前3D-RVEF预测IDH的敏感度和特异度较高,可为临床评估血液透析患者右心功能状态及调整血液透析方案提供参考依据。

Objective: To investigate the value of three-dimensional echocardiography(3DE) and two-dimensional speckle tracking imaging(2D-STI) in quantitatively evaluating changes of right ventricular function before and after hemodialysis in patients with end-stage renal disease(ESRD), right ventricular systolic function in patients undergoing intradialytic hypotension(IDH) and predicting IDH. Methods: 124 patients with clinically diagnosed ESRD who underwent maintenance hemodialysis were selected as ESRD group. According to whether the patients had IDH, they were divided into 56 cases of IDH group and 68 cases of non-IDH group. 40 healthy people were selected as the control group. General data and routine echocardiographic parameters were collected in both groups, and then parameters includeing 3D-RVEF, 2D-RVFAC, RVFWLS and RVGLS were obtained. Echocardiogram data and hemodialysis data of patients with ESRD within 1 hour before and after hemodialysis were recorded. Finally, the differences of all parameters before and after hemodialysis in patients with ESRD were compared, and the related factors of ultrafiltration volume and ultrafiltration rate were analyzed. The differences of right ventricular function parameters between IDH group and non-IDH group were compared, and the predicted factors of IDH were explored by Logistic regression analysis. Results: (1) Compared with the ESRD group before hemodialysis, 3D-RVEF, RVFWLS, RVGLS of the ESRD group after hemodialysis increased, diameter and volume of right atrium and ventricular, systolic blood pressure, pulmonary artery systolic pressure of the ESRD group after hemodialysis decreased(P<0.05). (2) The change of TAPSE before and after hemodialysis in the ESRD group was negatively correlated with the ultrafiltration volume(r=-0.300, P<0.05).(3) Compared with the non-IDH group, 3D-RVEF, 2D-RVFAC of the IDH group before and after hemodialysis were lower(P<0.05).(4) Logistic regression analysis showed that 3D-RVEF was an independent predicted factor of IDH.(5) The sensitivity of 3D-RVEF for diagnosis of IDH with the cut-off point of 53.75% was 64.3%, and the specificity was 88.2%, with the Youden index of 0.525. Conclusion: (1) 3DE and 2D-STI can quantitatively evaluate parameters changes of right ventricular function before and after hemodialysis in patients with ESRD.(2) Right ventricular systolic function is significantly decreased in IDH patients compared with non-IDH patients. 3D-RVEF before hemodialysis has high sensitivity and specificity in predicting IDH, which can provide a reference for clinical evaluation of right ventricular function condition in hemodialysis patients and adjustment of hemodialysis plan.

参考文献：

[1] CHOU J A,STREJA E,NGUYEN D V,et al.Intradialytic hypotension,blood pressure changes and mortality risk in incident hemodialysis patients[J].Nephrology Dialysis Transplantation,2018,33(1):149-159.
[2] National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-S266.
[3] K/DOQI Work Group.K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients[J].Am J Kidney Dis,2005,45(4 Suppl 3):S1-S153.
[4] LANG R M,BADANO L P,MOR-AVI V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].Eur Heart J Cardiovasc Imaging,2015,16(3):233-270.
[5] AKYUZ A.Assessment of right ventricular systolic function in patients with chronic renal failure before and after hemodialysis by means of various echocardiographic modalities[J].Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology,2014,42(8):717-725.
[6] GIUSCA S,DAMBRAUSKAITE V,SCHEURWEGS C,et al.Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring[J].Heart,2010,96(4):281-288.
[7] LAI W W,GAUVREAU K,RIVERA E S,et al.Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography[J].Int J Cardiovasc Imaging,2008,24(7):691-698.
[8] 刘洪涛,王志刚,尹立雪.超声心动图评价慢性肾功能衰竭患者血液透析前后右心室功能[J].临床超声医学杂志,2018,20(5):310-313.
[9] PARK J B,LEE S P,LEE J H,et al.Quantification of right ventricular volume and function using single-beat three-dimensional echocardiography:a validation study with cardiac magnetic resonance[J].J Am Soc Echocardiogr,2016,29(5):392-401.
[10] 米玉红.右心室——从解剖、病生理到临床实践[J].中华急诊医学杂志,2017,26(8):839-849.
[11] HOUARD L,MILITARU S,TANAKA K,et al.Test-retest reliability of left and right ventricular systolic function by new and conventional echocardiographic and cardiac magnetic resonance parameters[J].Eur Heart J Cardiovasc Imaging,2021,22(10):1157-1167.
[12] KIRKELS F P,LIE O H,CRAMER M J,et al.Right ventricular functional abnormalities in arrhythmogenic cardiomyopathy:association with life-threatening ventricular arrhythmias[J].JACC Cardiovasc Imaging,2021,14(5):900-910.
[13] SUN M,CAO X,GUO Y,et al.Long-term impacts of hemodialysis on the right ventricle:assessment via 3-dimensional speckle-tracking echocardiography[J].Clin Cardiol,2018,41(1):87-95.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录